375 research outputs found
Low bone mineral density of the spine in adolescents with cerebral palsy relates to reduced correction of scoliosis after surgery
No full textAbstract Adolescents with cerebral palsy (CP) often require scoliosis surgery. Low bone mass may counteract benefits of surgical treatment. This study compares volumetric bone mineral density (vBMD) in adolescents with CP to age and sex matched healthy controls and evaluates its effect on scoliosis treatment. Computed tomogramms (CT) of 51 adolescents with CP (15.0 ± 2.6 years) were performed for scoliosis surgery and also used for vBMD calculation. Reference control vBMD values were calculated from 62 CT examinations of patients (15.1 ± 2.3 years) after trauma or conditions not related to bone mass. Z-scores were calculated based on the reference values. Correction of scoliosis in relation to vBMD was evaluated on perioperative spinal radiographs of operated adolescents with CP. Adolescents with CP had lower vBMD (123.3 ± 46.3 mg/cm3) than healthy controls (166.9 ± 31.4 mg/cm3). The lowest vBMD (97.3 ± 49.8 mg/cm3) had patients with CP and pathological fractures (n = 8). Male CP Z-scores (− 2.2 ± 1.6, n = 22) (16.2 ± 2.5 years) were significantly lower than female CP Z-scores (− 1.0 ± 1.3, n = 29) (14.1 ± 2.3 years). Higher vBMD (179.2 ± 45.4 mg/cm3, n = 41) correlated to scoliosis correction > 50% (average 67.0 ± 12%), while lower vBMD (134.9 ± 30.9 mg/cm3, n = 7) related to correction ≤ 50% (average 36.8 ± 14%). Non-ambulant adolescents with CP have lower vBMD values compared to a healthy population, which negatively affects surgical correction of scoliosis. Level of evidence/clinical relevance: Therapeutic Level III
Biochemische Ursachen der kumulativen Anthracyclin-Kardiotoxizität — Ansatzpunkte für eine kardioprotektive Begleittherapie?1
No full textKumulative Anthracyclin-Kardiotoxizität. Möglichkeiten für eine kardioselektive Protektion durch Begleittherapie mit Isozitrat und Niacin
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Relationship between baseline hepatic status and outcome, and effect of sorafenib on liver function : SHARP trial subanalyses
No full textBackground & Aims: Hepatic markers are utilized in many classification systems of patients with hepatocellular carcinoma and, by measuring organ damage and tumor stage, can influence treatment. Moreover, elevated serum concentrations of aminotransferases and alpha-fetoprotein are indicators of poor prognosis in patients with hepatocellular carcinoma. We examined the effects of sorafenib on hepatic markers by performing exploratory subset analyses of the Sorafenib HCC Assessment Randomized Protocol (SHARP) trial in patients categorized by baseline concentrations of alanine aminotransferase/aspartate aminotransferase, alpha-fetoprotein, and bilirubin; and by evaluating the effects of sorafenib on bilirubin concentrations during treatment. Methods: Patients (n = 602) were grouped by baseline concentrations of alanine aminotransferase/aspartate aminotransferase (not significantly elevated, mildly elevated, or moderately elevated), alpha-fetoprotein (normal or elevated), and bilirubin (normal or elevated). Bilirubin was measured at baseline and on day 1 of each cycle. Results: Patients with elevated baseline concentrations of alanine aminotransferase/aspartate aminotransferase, alpha-fetoprotein, or bilirubin had shorter overall survival (OS) than those with normal baseline concentrations, irrespective of treatment group. No notable differences in safety profiles were observed between patients with normal vs. elevated alanine aminotransferase/aspartate aminotransferase, alpha-fetoprotein, or bilirubin. Median changes from baseline in bilirubin concentration at the last cycle of treatment were +0.17 and +0.19 mg/dl in the sorafenib and placebo groups, respectively. Conclusions: These subset analyses suggest that sorafenib is safe and effective for hepatocellular carcinoma, irrespective of baseline alanine aminotransferase/aspartate aminotransferase, alpha-fetoprotein, or bilirubin concentration and that hepatic function remains stable over the course of sorafenib therapy
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